Prenatal deficiency of phosphate, phosphate supplementation, and rickets in very-low-birthweight infants

Holland, P.; Wilkinson, AndrewR.; Díez, J.; Lindsell, D. R. M.

doi:10.1016/0140-6736(90)90810-r

Cited by 48 publications

(24 citation statements)

References 15 publications

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“…Phosphate deficiency is typically associated with hypercalciuria, whereas phosphate supplementation decreases urinary calcium excretion 28. Excess phosphate administration may result in renal rather than skeletal deposition of calcium 29…”

Section: Discussionmentioning

confidence: 99%

Nephrocalcinosis in preterm babies

Narendra

White

Rolton

et al. 2001

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objectives-To determine prospectively the incidence and cause of nephrocalcinosis in preterm infants. Study design-Inborn babies of gestation less than 32 weeks or birth weight less than 1500 g were eligible to be entered into a prospective observational study. Two renal ultrasound scans were performed, the first at 1 month postnatal age and the second at term or discharge. Data were collected on gestation, birth weight, sex, race, family history of renal calculi, oliguria on first day, respiratory support (ventilation, steroid, and oxygen dependency), and use of nephrotoxic drugs (gentamicin, vancomycin, and frusemide). Intake of fluid, calcium, and phosphate and plasma urea, creatinine, calcium, and phosphate were recorded for the first 6 weeks of life. Random urinary calcium/creatinine, oxalate/ creatinine, and urate/creatinine ratios and tubular absorption of phosphate were measured once at term. Results-A total of 101 preterm infants were studied. Twenty three (23%) had abnormal ultrasound scans. Sixteen (16%) had nephrocalcinosis. On univariate analysis, gestational age, male sex, duration of ventilation, oxygen dependency, duration and frequency of gentamicin treatment, toxic gentamicin/vancomycin levels, and postnatal dexamethasone were significantly associated with nephrocalcinosis. In addition, babies with nephrocalcinosis had a lower intake of fluid, calcium, and phosphate, longer duration of total parenteral nutrition, and higher urinary oxalate/creatinine and urate/ creatinine ratios than infants who did not have the condition. There was also a significant association with plasma urea and creatinine but not with plasma calcium or phosphate or urinary calcium. Multivariate analysis showed that the strongest predictors of nephrocalcinosis were duration of ventilation, toxic gentamicin/vancomycin levels, low fluid intake, and male sex. Conclusion-16% of babies born at less than 32 weeks gestation developed nephrocalcinosis. The multifactorial origin, in particular, the association with extreme prematurity and severity of respiratory disease, is confirmed. In addition, an association with male sex, frequency and duration of gentamicin use, and high urinary oxalate and urate excretion is shown. (Arch Dis Child Fetal Neonatal Ed 2001;85:F207-F213)

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Section: Discussionmentioning

confidence: 99%

Nephrocalcinosis in preterm babies

Narendra

White

Rolton

et al. 2001

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…It has been reported that use of serum P levels in combination with ALP, increases the sensitivity of screening and contributes to specifying preterm babies who carry a risk for osteopenia (22)(23)(24). Backstrom et al (25) reported that a serum ALP value above 900 U/L was related with low bone mineral density, its sensitivity was 88% and specificity was 71% and a serum P level of <5,5 mg/dL was related with low bone mineral density and its sensitivity was 96% and specificity was 50%.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the place of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity

et al. 2015

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Aim: In this study, we aimed to investigate the utility of tubular reabsorption of phosphorus in the diagnosis of osteopenia of prematurity in addition to biochemical markers. Material and Methods: Premature babies with a gestational age of ≤32 weeks and/or a birth weight of ≤1 500 g who were hospitalized in the neonatal intensive care unit between June 2009 and March 2011 were included in the study. These babies were evaluated at the 40th gestational week and serum calcium, phosphorus, alkaline phosphatase, urea, creatinine, urinary calcium and phosphorus levels were measured and tubular reabsorption of phosphorus was determined. The subjects who had bone graphy findings and/or an alkaline phosphatase level of >400IU/L and a phosphorus value of <3.5 mg/dL were considered osteopenic. The levels of tubular reabsorption of phosphorus of the osteopenic patients were compared with the ones of the non-osteopenic patients. The study was initiated after obtaining ethics committee approval (date: 04.29.2009/213). Results: During the study period, a total of 698 premature babies were hospitalized in our neonatology unit. A diagnosis of osteopenia of prematurity was made in 24 of 190 subjects who met the study criteria. The level of tubular reabsorption of phosphorus was compared with the serum calcium, phosphorus and alkaline phosphatase levels measured at the 40th gestational week and alkaline phosphatase was found to be significantly increased in the group with a high tubular reabsorption of phosphorus (≥%95). When the subjects with a phosphorus level of <3.5 mg/dL and an alkaline phosphatase level of >499 IU were compared with the newborns who were found to have a tubular reabsorption of phosphorus of ≥%95 for the objective of evaluating the specificity and sensitivity of tubular reabsorption of phosphorus, the sensitivity, specificity, positive predictive value and negative predictive value of tubular reabsorption of phosphorus in the diagnosis of osteopenia were found to be 27%, 82%, 17% and 89%, respectively. When the osteopenic and non-osteopenic patients were compared in terms of the levels of tubular reabsorption of phosphorus, no statistically significant difference was found. Conclusions: It was thought that it was not appropriate to use tubular reabsorption of phosphorus alone in the diagnosis of osteopenia of prematurity. (Türk Ped Arş 2015; 50: 45-50)

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“…Severe demineralisation has also been described in infants born to mothers with chorioamnionitis and placental infection 8 . There is a higher incidence of postnatal rickets in babies with IUGR, suggesting that chronic damage to the placenta may alter phosphate transport 9 . VLBW, delayed establishment of full enteral feedings and long term use of parenteral nutrition are risk factors for OOP.…”

Section: Risk Factorsmentioning

confidence: 99%